Predictors of Treatment Failure in Urethrocutaneous Fistula Repair for Hypospadias: A Retrospective Analysis

Abstract Purpose This study aimed to identify risk factors associated with the recurrence of urethrocutaneous fistula (UCF) following repair in patients with hypospadias, beyond the intrinsic characteristics of the fistula itself. Methods Clinical data of patients who underwent UCF repair were retrospectively reviewed. Potential risk factors included age and body mass index at UCF repair, history of low birth weight and prematurity, urethral defect length, operative approaches and urethral covering during hypospadias repair (HR), interval between urethroplasty and UCF presentation, interval between urethroplasty and UCF repair, meatal stenosis, size, number and location of UCFs. Univariate and multivariate analysis were used to identify the risk factors of UCF recurrence. Results A total of 136 patients underwent UCF repair from 2013 to 2022, and UCF recurred in 31 patients (22.8%) after a median follow-up of 36.2 months. Results of multivariate analysis showed that the UCF with a diameter exceed 4mm (OR6.968, 95% CI 1.522–31.898, P=0.012), multiple UCFs (OR 4.017, 95% CI 1.284–12.571, P=0.017), coronal UCF (OR 2.964, 95% CI 1.142–7.695, P=0.026) and urethral covering with non-Buck’s fascia (OR 2.631, 95% CI 1.015–6.819, P=0.047) were statistically significant, correlating with the risk of UCF recurrence. Conclusion UCF repair was more prone to failure if the size of UCF exceeds 4 mm, if it is located at the coronary sulcus, if multiple UCFs are present. Employing Buck’s fascia during HR would reduce the incidence of UCF recurrence.